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Funding Accountable Care in Oregon: Financial Models in Two Coordinated Care Organizations
Lauren Broffman1, Kristin Brown, Bruce K Bayley
1Lauren Broffman, associate research scientist, Providence Center for Outcomes Research and Education, Providence Health & Services, Portland, Oregon; Kristin Brown, administrator, Providence Center for Outcomes Research and Education, Providence Health & Services, Portland; K. Bruce Bayley, PhD, former director, Providence Center for Outcomes Research and Education, Providence Health & Services, Portland; Lucy Savitz, PhD, director of research and education, Intermountain Healthcare Institute for Health Care Delivery Research, Salt Lake City, Utah, and professor, Clinical Epidemiology, University of Utah School of Medicine, Salt Lake City; and Jill Rissi, PhD, associate professor, Division of Public Administration, Mark O. Hatfield School of Government, Portland State University, Oregon.
Executive Summary:
Oregon's coordinated care organizations (CCOs) are an integral part of a massive statewide reform that brings accountable care to Medicaid. CCOs are regional collaboratives among health plans, providers, county public health, and communitybased organizations that administer a single global budget covering physical, mental, and dental healthcare for low-income Oregonians. CCOs have been given freedom within the global budget to implement reforms that might capture efficiencies in cost and quality. For this study-fielded between 2012 and 2015-we traced the path of the global budget through the interior structures of two of Oregon's most promising CCOs. Using document review and in-depth qualitative interviews, we synthesized and summarized descriptive narrative data to produce case studies of the financial models in each CCO. We found that the CCOs feature substantially different market contexts, governance models, organizational structures, and financial systems.